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How is ketamine differentiated?

By lack of respiratory/myocardial depression

MOA of ketamine

Antagonizes NMDA receptors

Which IV induction agent is associated w/ anti-analgesic properties?

Na thiopental

What is the only IV induction agent that is associated w/ no amount of histamine release?

Etomidate

In addition to hepatic, renal, & enzymatic metabolism, these organs often have a significant role in the metabolism of IV induction agents, particularly propofol?

The lungs

Effects of propofol on ICP, CMRO2, CBF?

Decreases them

Propofol causes ____-____ on EEG

burst suppression

What happens to etomidate upon entry to the cell?

It undergoes molecular rearrangement, where lipid solubility increases (similar to versed)

What does etomidate suppress?

The reticular activating system (RAS)

Effects of etomidate on the EEG

Increases EEG potentials, good for seizure mapping

How does etomidate affect CBF, CMRO2, & ICP?

Decreases them

Etomidate can cause myoclonus d/t ____ ____.

subcortical inhibition

Etomidate produces burning upon injection d/t ____ _____.

propylene glycol

Etomidate causes ____ of _____ ____ ____ for up to 8 hours.

suppression of adrenocortical hormone synthesis

What does ketamine produce?

'Dissociative anesthesia' by inhibiting thalamocortical pathway/stimulating limbic system

How does ketamine affect ICP?

Increases it d/t cerebral vasodilation

Ketamine ____ IOP

increases

How is the emergence delirium associated w/ ketamine treated?

Versed/propofol

Why should ketamine be used cautiously in patients w/ cardiac complications & CAD?

Increases workload on the heart & O2 consumption

Ketamine causes ____, even though is _____ oral secretions.

bronchodilation
increases

Effects of barbiturates on ICP, CMRO2, CBF.

Decreases them

What do barbiturates induce?

Reverse cerebral steal (Robin Hood effect) & free radical scavenging = neuroprotective

Barbiturates cause ___-___ on EEG

burst-suppression

In what patients are barbiturates contraindicated?

Asthmatics (histamine release), & intermittent porphyria

Are benzos lipid or H20 soluble?

Mostly lipid soluble except midazolam (H20 soluble until encountering the body's pH at the lipid bilayer)

How are benzos metabolized?

Primarily hepatic w/ renal excretion

In regard to metabolism, what does diazepam & lorazepam produce and what is the effect?

Active metabolites
Prolonged DOA

Effects of benzos on CMRO2 & CBF

Decreases them

How are benzos reversed?

W/ flumazenil 0.1 mg q 30 s - 1 min

Which IV anesthetic agent comes closest to being a sole anesthetic agent?

Ketamine

How does one treat an intraarterial barbiturate injection?

Heparin, papaverine, lidocaine, phentolamine, or sympathectomy

T/F Propofol is safe to administer to a pt w/ a documented allergy to eggs

True...but it is contraindicated by the manufacturer

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